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Atrofia vaginal : um diálogo necessário
- 1. Dra Dolores Pardini Atrofia Vaginal: um diálogo necessário
- 2. Declaração de conflitos de interesse Dra Dolores Pardini • Sou palestrante neste evento a convite de Besins Healthcare
- 3. IRREGULARIDADES MENSTRUAIS Atrofia genital Dispareunia Prurido vaginal Infecções vaginais de repetição Maior freqüência de infecções urinárias Incontinência urinária Bexiga Hiperativa Doença Cardiovascular Osteoporose Demências MENOPAUSA CURTO PRAZO MÉDIO PRAZO LONGO PRAZO Tempo Fogachos Insônia Labilidade de humor Irritabilidade Desânimo Falta de concentração
- 4. Evolução dos fogachos ao longo do tempo Politi MC et al. J Gen Intern Med. 2008;23(9):1507
- 5. Dennerstein L et al. Obstet Gynecol. 2000;96:351 Secura vaginal e sua relação com o climatério
- 6. Atrofia Vulvovaginal Condição comum na pós-menopausa Deficiência estrogênica Sintomas não diminuem com o tempo, ao contrário dos fogachos. Sem melhora espontânea Lynch, 2009; Portman et al., 2014
- 7. Menopausa Pré Menopausa Efeito do Estrogenio no Epitelio Vaginal
- 8. Presença de receptores estrogênicos Trinkaus M et al, 2008
- 10. • N=3520 mulheres na pós-menopausa • EUA • Canadá • Europa • 45% com sintomas vaginais • 67% menopausa há >5 anos Estudo VIVA: The Vaginal Health: Insights, Views & Attitudes Nappi RE, Kokot-Kierepa M. Climacteric. 2012;15:36-44
- 11. Estudo VIVA (EUA) Vaginal Health:Insights, Views & Attitudes Simon et al. Menopause 2013;20:1043-8 • N=500 Afeta negativamente a vida Consequências negativas para a vida sexual Sentimento de “menos atraente” e 36% de “sentir velha” Consequências negativas para o relacionamento Esperaram um ano para procurar o médico
- 12. ▪ 57% sintomas de atrofia vaginal ▪ 71% consideravam como condição não crônica. Muitas mulheres não procuraram atenção de saúde por este motivo ▪ 73% consequências negativas sobre a vida sexual ▪ 36% afeta negativamente a vida ▪ 15% sentimento de “menos atraente" Nappi RE et al. Climacteric 2018;21:397-403 • 2.509 mulheres na pós-menopausa • 55-65 anos • Argentina, Brasil, Chile, Colômbia e México Estudo VIVA América Latina
- 13. Estudo VIVA (Brasil) N=504 Pompei LM, Wender MCO, de Melo NR, Kulak J Jr, Pardini D, Machado RB, Fernandes CE, Palacios S, Nappi RE.. Climacteric. 2020 Sep 1:1-7. Vaginal Health:Insights, Views & Attitudes
- 14. Estudo VIVA (Brasil) Pompei LM, Wender MCO, de Melo NR, Kulak J Jr, Pardini D, Machado RB, Fernandes CE, Palacios S, Nappi RE.. Climacteric. 2020 Sep 1:1-7.
- 15. Estudo CLOSER (Brasil) N=360 mulheres + 352 homens Pompei LM et al, submetido à publicação em 2020 Clarifying Vaginal Atrophy’s Impact on Sex and Relationships
- 16. Estudo VIVA * Adaptado de Nappi RE, Kokot-Kierepa M. Climacteric. 2012;15:36-44 35% 33% 51% 53% 56% 60%
- 17. Sintomas vaginais: abordagem deficiente Simon JA et al. Poster presented at North American Menopause Association Annual Meeting 2007
- 18. Conclusões • A incidência da Síndrome Genito Urinária da Menopausa é alta e não melhora sem tratamento adequado • A atrofia vaginal pode acarretar disfunção sexual, não apenas para a mulher, mas também para seu parceiro. • Existem barreiras ao tratamento que incluem relutância de médicos e pacientes em discutir os sintomas de AVV e desconhecimento em relação ao alívio dos sintomas com os tratamentos disponíveis
- 19. OBRIGADA!
Notas do Editor
- Este e o próximo slide são para mostrar que há um pico dos fogachos por volta de 1-2 anos, mas depois, a prevalência vai diminuindo, enquanto, segundo o estudo clássico de Dennerstein, as manifestações da atrofia urogenital apenas pioram com o tempo.
- In a longitudinal, population-based study of 438 women aged 45 to 55 years, Dennerstein et al1 found that the percentage of women reporting vaginal dryness increased progressively as women approached and passed through menopause. In premenopause, only 3% of women reported vaginal dryness compared with 25% of women postmenopausal by 1 year and 47% of women postmenopausal by 3 years.
- Climacteric . 2016 Apr;19(2):188-97. doi: 10.3109/13697137.2015.1107039. Epub 2015 Nov 19. Vulvar and vaginal atrophy in four European countries: evidence from the European REVIVE Survey R E Nappi 1, S Palacios 2, N Panay 3, M Particco 4, M L Krychman 5 Affiliations expand PMID: 26581580 PMCID: PMC4819825 DOI: 10.3109/13697137.2015.1107039 Free PMC article Erratum in Erratum.[No authors listed]Climacteric. 2016 Apr;19(2):i. doi: 10.3109/13697137.2016.1139299. Epub 2016 Jan 13.PMID: 26760758 No abstract available. Abstract Objectives: The aim of the European REVIVE survey was to achieve a better understanding of vulvovaginal atrophy (VVA), a chronic and progressive condition after menopause. We investigated perceptions, experiences and needs in terms of sexual and vaginal health in a sample of European postmenopausal women. Methods: An online internet based survey was conducted in Italy, Germany, Spain and the UK with a total surveyed sample of 3768 postmenopausal women (age: 45-75 years). Results: The most common VVA symptom was vaginal dryness (70%). VVA has a significant impact on the ability to be intimate (62%), to enjoy sexual intercourse (72%) and to feel sexual spontaneity (66%). Postmenopausal women with VVA are sexually active (51%), but their sexual drive is reduced. Health-care professionals (HCPs) have discussed VVA with postmenopausal women (62%), but they initiated the conversation only in 10% of the cases. The most common treatments for VVA are over-the-counter, non-hormonal, local vaginal products. Thirty-two per cent of postmenopausal women were naïve to any kind of treatment, whereas discussion with the HCP was relevant to be on current treatment (60% of postmenopausal women that discussed VVA with a HCP vs. 23% who did not). The top reasons for poor compliance with vaginal treatments were: not bothersome enough symptoms (18%); vaginal changes not therapeutically reversed (18%); relief from VVA symptoms (17%). Approximately 45% were satisfied with treatment. The most frequent disliked aspects of treatment were the route of administration or the messiness. The fear of hormones was common in postmenopausal women using vaginal prescription products. Conclusions: The European REVIVE survey confirmed that VVA symptoms are frequent in postmenopausal women and demonstrates a significant impact on quality of life and sexual life. However, the condition is still under-diagnosed and under-treated, with a high rate of dissatisfaction for actual available treatments in the four European countries surveyed. The discussion of symptoms with HCPs seems the most critical factor for diagnosis and treatment of VVA. Keywords: Europe; REVIVE Survey; Vulvar and vaginal atrophy; dyspareunia; postmenopausal women; sexual relationships; treatment; vaginal dryness.
- Impact of postmenopausal vaginal discomfort on sex and relationships in Brazil: the CLOSER Survey ESTUDO SUBMETIDO À PUBLICAÇÃO EM 2020 Abstract Objective: CLOSER investigated how postmenopausal vaginal atrophy (VA) affects relationships between women and male partners. Methods: Postmenopausal women (55–65 years) with VA, and male partners of women with the condition, completed an online survey on the impact of VA and local estrogen treatment on intimacy and relationships. Results: 360 women and 352 men from Brazil were included. Women (83%) and men (91%) reported that they were comfortable discussing VA with their partners. Women’s key source of information on VA was healthcare providers (HCPs), but 44% felt that not enough information is available. VA caused 70% of women to avoid sexual intimacy and resulted in less satisfying sex. VA had a negative impact on women’s feelings and self-esteem. Women (76%) and men (70%) both reported that treatment with vaginal estrogen improved their sexual relationship, primarily by alleviating women’s pain during sex. Women (56%) and men (59%) felt closer to each other after treatment. Conclusions: VA had a negative impact on sexual relationships for both women and men in Brazil, and reduced women’s self-confidence. Vaginal hormone therapy improved couples’ sexual relationships. A proactive attitude of HCPs is essential to educate women on VA and the potential benefits of treatment. Keywords: vaginal dryness; vaginal atrophy; discomfort; postmenopausal; local estrogen therapy; male partner; genitourinary syndrome
- Nearly half of women 45 years and older say they are not comfortable or would not begin a discussion of vaginal symptoms with their HCP Most HCPs do not ask patients about vaginal symptoms: 70% say that their HCP only rarely or never asks about problems like vaginal dryness The total is less than 100%, because 1.3% of the sample refused to answer the question Postmenopausal women may not be educated on their condition, and therefore do not seek treatment Reference: Simon JA, et al. Poster presented at North American Menopause Association Annual Meeting. 2007